Personality disorders are enduring patterns of behavior and cognition that deviate from cultural norms and cause distress or impairment. They are classified into three clusters - A, B, and C - based on clinical characteristics. Borderline personality disorder, the most common diagnosis, is characterized by instability in interpersonal relationships, self-image, and affect. Treatment involves psychotherapy such as dialectical behavior therapy or psychodynamic therapy, as well as medication management when comorbid conditions are present. Prognosis is variable, with about one-third recovering over time and intervention improving outcomes.
Relational Strategies Working with Borderline Clients (Brief Version)Daryush Parvinbenam
By: Daryush Parvinbenam
Core Issues: Dawson (1993) suggests, chronic patterns of abuse/neglect experiences must have imposed an enduring sense of lack of control, incompetence, and power in the client' psyche.
Relational Complexities Working with Women with History of Childhood Sexual A...Daryush Parvinbenam
By: Daryush Parvinbenam, M.A., M.Ed., LPCC, LICDC
Core Issues: "Translated to emotional and psychological trauma and pain. Therefore control, power, and competence must be maintained in order to prevent future traumas or re-experiencing past in borderlines' experience being vulnerable and lacking control and power, has historically traumatic emotional memories."
During the formative years of contemporary psychiatry, much attention was paid to the continuing role of past traumatic experiences on the current lives of people.
Relational Strategies Working with Borderline Clients (Brief Version)Daryush Parvinbenam
By: Daryush Parvinbenam
Core Issues: Dawson (1993) suggests, chronic patterns of abuse/neglect experiences must have imposed an enduring sense of lack of control, incompetence, and power in the client' psyche.
Relational Complexities Working with Women with History of Childhood Sexual A...Daryush Parvinbenam
By: Daryush Parvinbenam, M.A., M.Ed., LPCC, LICDC
Core Issues: "Translated to emotional and psychological trauma and pain. Therefore control, power, and competence must be maintained in order to prevent future traumas or re-experiencing past in borderlines' experience being vulnerable and lacking control and power, has historically traumatic emotional memories."
During the formative years of contemporary psychiatry, much attention was paid to the continuing role of past traumatic experiences on the current lives of people.
Effective Approaches to Helping Clients Who Hurt Themselves and Sabotage Coun...Daryush Parvinbenam
By: Daryush Parvinbenam M.A., M.Ed., LPCC-S, LICDC
Etiology: "There could be many reasons for the intensification of clients' symptoms, relationship issues are only one of them. This is the focus of this presentation.
Personality Disorders-Dramatic, Emotional, and Erratic BehaviorsJennifer Cook
Personality disorders are incapacitating for some clients and render them unable to function normally in society. Young people and older people alike are affected by these disorders. Often leading to criminal behaviors, clients end up in jail and prison because of their mental illnesses where they will end up not getting the treatment so desperately needed. Plagued by dramatic, emotional, and erratic behaviors, a client, all too often contemplates suicide as an escape. These clients present with numerous other odd behaviors not understood by most making them inherently social outcasts. Although finding the right treatment is sometimes difficult, nurses have a duty to delve into the behaviors exhibited by these clients and assist in directing them to the appropriate treatment.
Conceptual understanding and outline for basic history taking in Psychiatric disorders, formulating a diagnosis based on the information and planning appropriate management for the same.
This topic is meant for the study purpose, for the final year undergraduate Physiotherapy students, who are studying under The Tamilnadu Dr.MGR Medical University (Govt University).
A quick overview of best practice treatments for mental disorders. Great for personal study, as flashcards, for study for the NCMHCE or similar exams, or as a presentation.
The Assessment, Management, and Treatment of Suicidal PatientsJohn Gavazzi
This PowerPoint is a companion to The Ethics and Psychology Podcast #25: The Assessment, Management, and Treatment of Suicidal Patients. Dr. John Gavazzi speaks with Dr. Sam Knapp about assessing, managing and treating the suicidal patient. Please read the disclaimer and the note on competence in dealing with suicidal patients. The podcast or video meets the requirements for Pennsylvania Act 74 requirements for all mental health professionals in Pennsylvania.
Psychological resilience is defined as an individual's ability to properly adapt to stress and adversity. Stress and adversity can come in the shape of family or relationship problems, health problems, or workplace and financial worries, among others.
Creating and reinforcing psychological health is the goal in successfully living a balanced lifestyle. Learn to preserve and promote psychological health!.
Effective Approaches to Helping Clients Who Hurt Themselves and Sabotage Coun...Daryush Parvinbenam
By: Daryush Parvinbenam M.A., M.Ed., LPCC-S, LICDC
Etiology: "There could be many reasons for the intensification of clients' symptoms, relationship issues are only one of them. This is the focus of this presentation.
Personality Disorders-Dramatic, Emotional, and Erratic BehaviorsJennifer Cook
Personality disorders are incapacitating for some clients and render them unable to function normally in society. Young people and older people alike are affected by these disorders. Often leading to criminal behaviors, clients end up in jail and prison because of their mental illnesses where they will end up not getting the treatment so desperately needed. Plagued by dramatic, emotional, and erratic behaviors, a client, all too often contemplates suicide as an escape. These clients present with numerous other odd behaviors not understood by most making them inherently social outcasts. Although finding the right treatment is sometimes difficult, nurses have a duty to delve into the behaviors exhibited by these clients and assist in directing them to the appropriate treatment.
Conceptual understanding and outline for basic history taking in Psychiatric disorders, formulating a diagnosis based on the information and planning appropriate management for the same.
This topic is meant for the study purpose, for the final year undergraduate Physiotherapy students, who are studying under The Tamilnadu Dr.MGR Medical University (Govt University).
A quick overview of best practice treatments for mental disorders. Great for personal study, as flashcards, for study for the NCMHCE or similar exams, or as a presentation.
The Assessment, Management, and Treatment of Suicidal PatientsJohn Gavazzi
This PowerPoint is a companion to The Ethics and Psychology Podcast #25: The Assessment, Management, and Treatment of Suicidal Patients. Dr. John Gavazzi speaks with Dr. Sam Knapp about assessing, managing and treating the suicidal patient. Please read the disclaimer and the note on competence in dealing with suicidal patients. The podcast or video meets the requirements for Pennsylvania Act 74 requirements for all mental health professionals in Pennsylvania.
Psychological resilience is defined as an individual's ability to properly adapt to stress and adversity. Stress and adversity can come in the shape of family or relationship problems, health problems, or workplace and financial worries, among others.
Creating and reinforcing psychological health is the goal in successfully living a balanced lifestyle. Learn to preserve and promote psychological health!.
Definition
DEFINITION
An abnormal personality is one in which there are “ deeply ingrained maladaptive pattern’s behavior recognizable by the time of adolescence or earlier and confining through most of adult life because of this ,the patient suffer or others have to suffer and there is an adverse affect on the individual or on society.
Classification or clusters
Cluster A
Cluster B
Cluster C
Causes
Diagnosis
Treatment
Personality means enduring qualities of a person in many circumstances. It includes perceptions, attitudes and emotions. These behaviors and characteristics are consistent across a broad range of situations and do not change easily. A person usually is not consciously aware of his/ her personality. Many factors influence personality; some stem from biologic and genetic makeup, whereas some are acquired as a person develops and interacts with the environment and other people. These qualities develop into personality traits(Characters).
PERSONALITY TRAITS:
The most widely used system of personality trait is called Five- Factor Model. This includes, Openness, Conscientiousness, Extraversion, Agreeableness and Neuroticism. Each trait is further divided into several trait facets to analyse one’s personality clearly. Several theorists still argue that there are more traits which have not been captured by this five-factor model.
Openness people loves adventure, appreciate art, imagination and learn new things throughout their life time. Meanwhile low openness people avoid new experiences, stick to their habits and not adventure lovers.
Conscientiousness people are dependable, disciplined and achievement focused. Meanwhile low conscientiousness people are more spontaneous and careless, when extreme.
Extraversion people/ Extroverts are cheerful, sociable and draw energy from crowds. Meanwhile introverts love to be alone. Commonly people think introversion and shyness are same. They both are different. Shyness people has fear of social interaction meanwhile introverts are cheerful but they prefer solo or small group activities.
Agreeableness people are warmth, kind, helpful, compassionate and trust worthy. Meanwhile disagreeable people are cold and suspicious of others.
High Neuroticism people experience lot of negative emotion. Meanwhile low neuroticism people will be emotionally stable.
Personality disorder is defined as, “characteristic and enduring pattern of inner experience (or) behavior as a whole marked deviation for a level of exception and acceptable range of individuals’ culture”. – ICD 10
Personality means enduring qualities of a person in many circumstances. It includes perceptions, attitudes and emotions. These behaviors and characteristics are consistent across a broad range of situations and do not change easily. A person usually is not consciously aware of his/ her personality. Many factors influence personality; some stem from biologic and genetic makeup, whereas some are acquired as a person develops and interacts with the environment and other people. These qualities develop into personality traits(Characters).
PERSONALITY TRAITS:
The most widely used system of personality trait is called Five- Factor Model. This includes, Openness, Conscientiousness, Extraversion, Agreeableness and Neuroticism. Each trait is further divided into several trait facets to analyse one’s personality clearly. Several theorists still argue that there are more traits which have not been captured by this five-factor model.
Openness people loves adventure, appreciate art, imagination and learn new things throughout their life time. Meanwhile low openness people avoid new experiences, stick to their habits and not adventure lovers.
Conscientiousness people are dependable, disciplined and achievement focused. Meanwhile low conscientiousness people are more spontaneous and careless, when extreme.
Extraversion people/ Extroverts are cheerful, sociable and draw energy from crowds. Meanwhile introverts love to be alone. Commonly people think introversion and shyness are same. They both are different. Shyness people has fear of social interaction meanwhile introverts are cheerful but they prefer solo or small group activities.
Agreeableness people are warmth, kind, helpful, compassionate and trust worthy. Meanwhile disagreeable people are cold and suspicious of others.
High Neuroticism people experience lot of negative emotion. Meanwhile low neuroticism people will be emotionally stable.
Personality disorder is defined as, “characteristic and enduring pattern of inner experience (or) behavior as a whole marked deviation for a level of exception and acceptable range of individuals’ culture”. – ICD 10
AssignmentRespond to at least two of your colleagues .docxnormanibarber20063
Assignment:
Respond
to at least
two
of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned. What are their similarities and differences? How might you differentiate the two diagnoses?
Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format.
Colleagues Respond # 1
Diagnostic Criteria for Boderline Personality Disorder
Patients suffering from Borderline Personality Disorder have a fear of abandonment or difficulty in sustaining being left alone (Gunderson et al., 2018). It usually starts at a minor age and worsen in young adulthood but may resolve with age later in life. Persons with borderline respond well to the treatment and can live satisfying lives for long. A client with borderline personality disorder has a pattern of unstable interpersonal relationships, poor self-image, impulsivity, and unstable mood and affect (Sadock, Sadock, & Ruiz, 2014). Diagnostic and Statistical Manual of Mental Disorders (DSM 5) notes that five or more criteria should be met which include affective instability, inappropriate anger, impulsivity, unstable relationships, feelings of emptiness, paranoia or dissociation, identity disturbance, abandonment fears, and suicidality or self-injury (Hall & Riedford, 2017). Hall and Riedford (2017) also note that most client display all these characteristics.
Evidenced-based Psychotherapy and Psychopharmacologic treatment for Boderline Personality Disorder
When one is diagnosed with a borderline personality disorder, there are several treatment modalities that the patient may be taken through. Psychotherapy is the mainstay treatment for borderline personality disorder. Also referred to as talk therapy, is use of psychological ways like personal interaction, listening to individual talk about their problems, also helping one overcome their obstacles (Borderline personality disorder - Symptoms and causes., 2018). “Several types of psychotherapy include; dialectical behavior therapy which is skills-based to enable educate individuals on how to handle their challenges and to tolerate stress. Schema-focused therapy, is focused on dealing with the unmet needs of the individual that might promote positive living. Transference-focused psychotherapy, assist the individual in understanding their emotions and difficulties through creating a relationship with the therapist” (Gunderson et al., 2018).
At the moment there are no specific drugs meant to manage borderline personality disorder, but treatment-using drugs might be done in the management of a patient presenting with depression, anxiety and impulsiveness (Gunderson et al., 2018). Aripiprazole has shown effectiveness in reductions in anger, impulsivity, depression, and anxiety (Parker & Naeem, 2019). Olanzapine has demonstrated some small improvemen.
Understand Clients Mental Health Diagnosis & Appropriately Interact with themuyvillage
Definition of mental illness. The causes of mental illness. Tips on how to empower youth with mental health disorders. Ways to teach skills to youth who have the following diagnosis: Reactive Attachment, Post Traumatic Stress Disorder, Oppositional Defiant Disorder, ADHD, Spectrum Disorders,
A powerpoint covering eating disorders for Mental, Emotional, and Behavior Disorders, VCU School of Social Work. From Corcoran & Walsh, Mental Health in Social Work.
Presentation on conducting literature reviews from Social Work Research Skills Workbook by Corcoran and Secret, VCU School of Social Work, Research on Clinical Social Work Practice.
A brief outline of sampling for graduate social work research students thinking about real-world problems in their agencies. This presentation accompanies chapter 7 in SOCIAL WORK RESEARCH SKILLS WORKBOOK.
1. Personality Disorders
Personality is the totality of emotional and behavioral
traits apparent in a person’s
ordinary life that is usually stable and predictable.
Personality traits are enduring patterns of perceiving,
relating to, and thinking about the environment and
the self that are exhibited in a wide range of contexts.
2. A personality disorder
deviant from cultural standards
rigidly pervasive
onset in adolescence or early adulthood
stable over time,
lead to unhappiness and impairment
maladaptive behavior in at least two:
1.Affect 2. Cognition 3. Impulse control
4. Interpersonal functioning
4. Cluster A:
odd and eccentric
more common in biological relatives of client with
schizophrenia
Types
Paranoid - distrust and suspiciousness
Schizoid - detachment from social relationships
Schizotypal -acute discomfort in close relationships,
cognitive or perceptual distortions, and eccentric behavior
5. Cluster B:
dramatic, emotional, erratic, defenses of dissociation,
acting out, denial, and splitting
Types
Antisocial - distrust of other and violations of their rights,
often co-morbid with substance use disorders
Borderline - instability in interpersonal relationships, self-image,
affect, and impulse control, often co-morbid with mood
disorders
Histrionic - excessive emotionality and attention-seeking, often
co-morbid with somatization
Narcissistic - grandiosity, a need for admiration, and a lack of
empathy
6. Cluster C:
These persons are anxious or fearful, and tend to
utilize the defenses of isolation,
passive aggression, and somatization
Types
Avoidant - social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation
Dependent - submissive and clinging behavior related to
an excessive need to be taken care of
Obsessive-compulsive - preoccupation with
orderliness, perfectionism, and control
7. Diagnostic Considerations
low inter-rater reliability with personality disorders
require a longitudinal versus a time-limited assessment approach
Psychological testing can be helpful
8. + Coding
principal diagnosis if focus on PD
should rarely be applied to children and
adolescents because personality patterns are
evolving during and don’t reach a state of
constancy until late adolescence/young
adulthood.
- Symptoms should be present for a full yr in
adolescence in order to diagnose
9. + Borderline Personality Disorder
a pattern of instability in interpersonal relationships, self-image,
and affect, featuring impulsive behavior
Characterized by extremely unstable affect, mood, object
relations, and self-image
frantic efforts to avoid abandonment
failed to successfully negotiate task of separating from primary caregivers
while maintaining an internalized sense of being cared for
often in crisis due to their intense feelings of anger, emptiness,
and hopelessness that occur when stressed
Other features include anxiety, transient psychotic symptoms,
suicidal or self-mutilating behaviors, and substance abuse.
Core features: highly variable mood and impulsive behavior
10. +
Prevalence of BPD
5.9%
most common personality disorder found in clinical settings
In clinical samples, most frequent in females but in population, males
and females have equal rates
11. +
Assessment
Determine through a social history whether the client’s presenting problems result from patterns of
interaction with others
Assess for recent stressors; determine whether isolated situation or part of a general pattern
Is the client’s presenting problem an outcome of conflicted interactions with significant
others? If so, is this an isolated situation, or part of a general pattern?
Does the client maintain positive relationships with some significant others (such as
friends, family, and co-workers), or are most relationships conflicted?
Influence of any substances that may account for the symptoms of anxiety and depression.
Medical condition
For older adolescents and young adults, determine whether relatively less severe identity concerns
are related to a developmental phase
The client’s manipulative behavior must be related to a desire for nurturance rather than a desire for
power, profit, or personal gain
12. +
Assessment
Is the client under the influence of any substances that might account for the symptoms of anxiety
and depression?
Is there evidence of a history of hypomanic or manic episodes? Of depressive episodes?
If the client is an older adolescent or young adult, are identity concerns related to a developmental
phase?
If the client displays manipulative behaviors toward others, including the social worker, are they
related to a desire to elicit nurturance or for power or personal gain?
What cultural conditions may be affecting the client’s relationship-seeking behavior?
What environmental conditions may be affecting the client’s relationship-seeking behavior?
13. + Co-Morbidity
mood disorders, substance related disorders,
eating disorders (notably bulimia), PTSD and
other anxiety disorders, dissociative identity
disorder, and attention deficit hyperactivity
disorder
Symptoms of depression characteristic of BPD -
emptiness, self-condemnation, abandonment
fears, hopelessness, self-destructiveness, and
repeated suicidal gestures
mood swings that resemble bipolar disorder (the
interpersonal conflicts are a differentiating factor)
14. + Suicidality and Self-Mutilation
55% of inpatients have histories of suicide
attempts, although suicide rate is 5-10%
Reasons for self-mutilation:
express anger,
punish oneself,
generate normal feelings when experiencing depersonalization,
or distract oneself from painful feelings
15. +
Risk and Protective Factors
37.1% genetic and 62.9% environmental influences
Psychodynamic formulation
Separation-individuation phase fixation – can’t distinguish between self and
others
have failed to successfully negotiate the delicate task of separating from
primary caregivers while maintaining an internalized sense of being cared
for.
Trauma in the social environment in childhood
16. +
Course
Variable
one-third recover ten years after initial diagnosis
Low SES do worse
a “natural course” recovery rate of 3.7% per year
clients receiving intervention recover at a rate seven
times that of persons who do not receive intervention
25% recovery rate per year for clients receiving
intervention.
Substance use -risk
17. +
Intervention
40-60% drop out prematurely
Components:
establishing and maintaining a therapeutic framework
and alliance
responding to crises and monitoring the client’s safety
providing education about the disorder
consistent supportive or insight-oriented therapy
coordinating intervention provided by other providers
18. +
Indications for partial or brief
inpatient hospitalization
Dangerous, impulsive behavior that can’t be managed in an
outpatient setting
Non-adherence with outpatient intervention and a deteriorating
clinical picture
Complex comorbidity that requires intensive clinical
assessment of response to intervention
Symptoms of sufficient severity to interfere with functioning,
work, or family life that are unresponsive to outpatient
intervention
Transient psychotic episodes associated with loss of impulse
control or impaired judgment
19. +
Contract for services
timing and frequency of sessions,
plans for crises management,
after-hours availability (if any)
expectations about scheduling, attendance, and payment.
20. + Dialetical behavior therapy
CBT and social learning, mindfulness
assumes core difficulty of clients is affective instability
"dialectical" intervention needs to address both biological and
environmental aspects of the disorder/self-acceptance and
change
intensive, one-year outpatient intervention that combines
weekly individual sessions with weekly skills-training groups
purpose of group– to teach adaptive coping skills in the areas
of emotional regulation, distress tolerance, interpersonal
effectiveness, and identity confusion, and to correct
maladaptive cognitions.
21. +
Modality of DBT
individual therapy, a formal skills-training group, a therapist
consultation team, some form of coaching (usually by telephone), and
a treatment length of at least six months for outpatient clients and two
months for inpatient clients.
22. + Psychodynamic Intervention
draws from three major theoretical perspectives:
ego psychology
object relations
self-psychology
23. + Exploratory-supportive continuum of interventions
Supportive
strengthening of defenses,
development of self-esteem,
validation of feelings,
internalization of the therapeutic relationship
creation of a greater capacity to cope with disturbing feelings
Exploratory
make unconscious patterns more consciously available
increase affect tolerance,
build a capacity to delay impulsive action
provide insight into relationship problems
develop reflective functioning toward a greater appreciation of internal motivation in
the self and others
24. +
Difficulty Prescribing Medication
disorder’s symptom heterogeneity
diagnostic unreliability
presence of comorbid disorders, and the
potential for self-destructiveness.
25. +
Types of medication
SSRI’s – mood and impulsive symptoms
Small, positive effects
For symptoms in cognitive dimension
(suspiciousness, illusions, depersonalization, or
transient hallucinations), antipsychotics
Review of antidepressant, anti-anxiety,
antipsychotic, anticonvulsants, and lithium
medications, either modest or no symptom relief
26. +
Critique
DSM doesn’t mention how long symptoms have to last
May meet the criteria in 126 different ways
Division between clinical disorders and personality disorders
questionable
High co-morbidity
Psychodynamic vs. atheoretical
Recovery rates
27. +
Critique for personality disorders
Personality disorders appear to
describe the total person, rather than
a particular aspect of the person or
the result of person-in-environment
processes